There are more new cases of child maltreatment per year than there are new cases per year of all forms of cancer across all age groups combined. Recent research indicates child maltreatment has serious long term psychiatric and medical sequelae. This project is comprised of a series of studies investigating the long-term psychological, biological, and social outcomes of childhood sexual abuse in female children. Prior results demonstrated significant dysregulation of the hypothalamic-pituitary-adrenal (HPA) and sympathetic-adrenal medullary axes in the maltreated children. Findings from recent Time 4 data collection indicate that, as a group, maltreated children manifest significantly different HPA and cardiovascular responses to neutral (mental rotation task) and traumatic (interview about exposure to traumatic events) stressors than do age-, gender-, race-, and socioeconomic status-matched control subjects. Differential physiological response to stressors appears to be related to the development of certain forms of serious psychopathology. Time 1 evaluation data are prospectively predictive of Time 4 physiological reactivity to stressors (mean interval 6.7 years).